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Help Please... Insurance is Killing me...

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Old 06-07-2006, 11:00 AM   #1
Join Date: May 2006
Location: Brooklyn, NY
Posts: 83
MaxTech23 HB User
Help Please... Insurance is Killing me...

I have Oxford and they cover almost nothing. Unfortunately my DH is not in the military so I don't have that coverage either. My question is... are there "regular" couples out there that have good news to share about the type of insurance they have. I live in NYS and could really use the help here. I realize it's cheaper for me to pay insurance out of pocket each month as opposed to having to pay all the medical bills out of pocket. And this way if I do have to have IVF, maybe my insurance will cover it.

Silly, mommy to be (one of these days anyway...)

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Old 06-07-2006, 11:31 AM   #2
Join Date: May 2006
Location: Near Peoria Illinois USA
Posts: 328
NitroChic HB User
Re: Help Please... Insurance is Killing me...

I am not sure what you wanted, but here goes. Hubby has family coverage on 4 of us.He and I and 17 yr old and 21 yr old student. His insurance REQUIRES that I subscribe to whatever insurance is offered at my job..I do. So I have double coverage. Mind you.....between the 2 of us we pay $300.00 per month. $500.00 per person deduct/1500.00 family then its 80/20.
I am currently going through agressive treatment for Osteomylitis of the jaw. Post debridment surgery by 2 weeks, 2nd debridment surgery scheduled for friday. I made it clear to the hospital ER and the Oral Surgeon that they would be accepting assignment of my insurance. Once we pay the weekly premiums, deduct, and co-pay for meds, there quite frankly isnt another dime to go for the 20% we are supposed to pay.I have never had anyone turn me down on this offer. I have to go see an Infectious Disease guy tomorrow for the first time, and I will see that they accept assignment before I set foot in the office.
I hope you can find coverage that fits you and can afford. BTW the military insurance is one of the worst in the country. MANY MANY physicians/providers wont accept that. It is truly a travesty.

Old 06-07-2006, 11:47 AM   #3
Join Date: May 2006
Location: Brooklyn, NY
Posts: 83
MaxTech23 HB User
Re: Help Please... Insurance is Killing me...

wow. I looked into my dh insurance and they won't cover much of anything. we are able to pay up to $400 monthly for a 2nd insurance for me. There really is no need for DH to get a second insurance since I am the one who will be using it not him. It's as though the insurance companies get frightened whenever I ask them if they cover infertility and if they do cover it, I want to know what they cover. My current insurance will cover IUI's but they will not cover IVF's. So sad about the military coverage, I was not aware that most places don't accept it. I don't want to drop my insurance as it's 100% coverage but it's only for me. My DH cannot be on my insurance. I swear, Medicaid pays for almost everything... if only I could have medicaid, maybe they'd pay for all these infertility drugs, tests, and procedures too. <~~ Kidding.
Thanks Nitro for your input.

I know my landlord's daughter has GHI and she only had to pay co-payments per office visit ($20). But when I called GHI they told me infertility is not covered so now I'm confused.

Silly, mommy to be (one of these days anyway...)

Old 06-07-2006, 01:30 PM   #4
Junior Member
Join Date: Apr 2006
Location: Florida
Posts: 21
dnclark HB User
Re: Help Please... Insurance is Killing me...

Hi MaxTech, Unfortunately, most insurance companies do not cover anything to do with infertility. I've even heard of some that won't cover the pregnancy if the child was concieved using fertility procedures...It sticks becuase for thsoe of us who dream about having a baby and can't have to expend so much more time energy and money to make our dream come true. My insurance company covers only diagnositic tests. Once I was diagnosed, they stopped paying. Luckily for me, I was able to concieve through just the use of medicine and didn't have to go for IUI or IVF. I wish you all the best and hope that you get that baby you so deserve!!!


Old 06-07-2006, 01:52 PM   #5
Join Date: Apr 2006
Location: Camden County, NJ
Posts: 60
Rebecca213 HB User
Re: Help Please... Insurance is Killing me...


You gotta to move a little south to New Jersey. We are one of the only states in the US that mandates that insurance companies cover fertility treatment. So what if our cost of living is crazy and you would pay through your nose for car insurance and property taxes...your fertility treatments would be covered, LOL!

So far, DH and I have paid very little. Everytime I go to the docs he gives me an untrasound...I have had a Sonahystogram and a Hysterosalpinogram (in the hospital). All we have paid are our co-pays. If we need to move on to IUI or IVF, we are covered. We are also fortunate that both DH and I, both work for the government, so we have excellent insurance and we do not pay a dime for it. I never realized how blessed we were!

I know that a lot of women on this site have trouble with insurance companies...every one of those companies are awful! Just keep your head up and try to stay positive.

Lots of luck and baby dust to you!

31/DH 33

TTC 2 years

Last edited by Rebecca213; 06-07-2006 at 01:56 PM.

Old 06-08-2006, 11:06 AM   #6
Join Date: May 2006
Location: Brooklyn, NY
Posts: 83
MaxTech23 HB User
Re: Help Please... Insurance is Killing me...

Thank you guys so much.
--Rebecca213 are you kidding?? NJ has that law? I had no idea. NJ is not far from me (I'm in Bklyn). We've toyed with the idea of moving someplace cheaper, ie Florida. But because we'd be paid a lot less, it would be the same thing or worse for us to move out there. we don't have a car because in NY the train and bus is everywhere, lol. Thank you so much for the tip. Hopefully the law doesn't change and who knows, maybe I'll consider moving out there in a yr or so (that's if I don't have a bundle of joy by then).

Thank you so much ladies...
lots of luck, love and sticky baby dust to all!!

Old 06-08-2006, 11:53 AM   #7
Senior Veteran
Join Date: Jun 2005
Location: Nebraska
Posts: 518
ravaemarie HB User
Re: Help Please... Insurance is Killing me...

I just did some research and found out that the following states have made it
"mandatory for employers with more than 50 employees to offer fertility insurance as part of regular health care coverage."

New York
New Jersey
West Virginia
Rhode Island

Unfortunately, I do not live in any of these states, but thought the information might help some of you out.


Old 06-08-2006, 12:50 PM   #8
Senior Member
Join Date: May 2006
Location: Louisiana
Posts: 229
Just~A~ HB User
Re: Help Please... Insurance is Killing me...

I guess I need to move BACK to Illinois. LOL!

Oh, well. Louisiana is as amazing as it is a royal PITA (is there such an ABBV.?).


Old 06-09-2006, 07:05 AM   #9
Join Date: May 2006
Location: Brooklyn, NY
Posts: 83
MaxTech23 HB User
Re: Help Please... Insurance is Killing me...

Just A, if there wasn't an abbr. for it before, there is one now.

RavaeMarie, Thank you so much. That's very helpful. I feel like crap a little. I was with a MUCH bigger company prior to Feb. In Feb I decided that I wasn't being paid enough and I then chose to change companies. I'm paid a little more now but it's still not enough. If only I would have made the decision to see a specialist prior to Feb, then I wouldn't have changed jobs. Jeez. funny how life works!!

So here's an update, I began the Metformin this morning. 500mg. So that's 1000mg/day for 2 wks, then 1500mg/day for 2 wks then bloodwork. I asked my RE if any of the meds affect an unborn child and he said no. But my old RE said that gluophage does affect unborn children and getting pregnant on it would be a disaster. Albeit, that was 7 yrs ago and I'm aware that numerous studies must have taken place since then... I'm so concerned now... I feel like a nut -- running to the computer everytime my RE names a drug, I feel this need to read up on it just in case. I'm very comfortable with my RE though. Even if I've only seen him once lol. I see the head nurse and talk to her a lot more often than I do my Dr. But that's cool as long as I can talk to someone who knows. But in all honesty, finding this forum and so many women in my position has been a blessing.

best wishes and sticky baby dust to all!!

Old 06-09-2006, 07:24 PM   #10
Senior Member
Join Date: Sep 2004
Location: Texas
Posts: 170
withinreach HB User
Re: Help Please... Insurance is Killing me...

Just a little insight on the insurance issue. There are some states that are mandated to cover and there are others that are mandated to offer it. I live in Texas and here they are mandated to offer it to employers but the employer does not have to include it in their packages...therefore many of us don't have coverage. I happened to ask my RE's office insurance person what companies she knew of that offered coverage and she told me TimeWarner cable had excellent infertility coverage for their employers. She also told me that Starbucks had some and of course she found out about CVS where my husband works (we have some). The part that upsets me the most is if we have insurance whether the insurance company has any coverage I think we should be able to pay the negotiated costs verses the cash paying cost. If I had a sono in by OB's office for an issue not related to infertility I would pay their negotiated costs, but if I am at my RE's office and they dont cover anything but I do have insurance they won't even bill and let me pay 100% of the negotiated cost...does that make sense. I am fortunate to have some coverage, but I still have to fight with them. Best of luck to all.

Old 06-11-2006, 12:33 AM   #11
Senior Veteran
Join Date: Sep 2004
Location: US
Posts: 753
Heyknack HB User
Re: Help Please... Insurance is Killing me...

Although my state (Illinois) is on that list and there is a law that insurance companies are supposed to offer coverage for diagnosis and treatment of infertility, due to a stupid loophole, many of us here also do not have infertility coverage or little coverage. Basically, if the insurance plan is written outside Illinois, then they can make their own rules. So that's basically all insurance companies, lol!! I have Cigna insurance through my husband...we have limited coverage. They will cover diagnosis of infertility, and treatment with pills, or IUI. They will not cover injections, IVF, ICSI, etc. I have heard other people with Cigna who do have full coverage...totally depends on what the employer has negotiated with the insurance company for coverage I guess. And I know many, many people with no coverage whatsoever. We got partial coverage, which is great...but it still could be better. All the most expensive treatments are of course not covered! It really isn't fair to have so many differences among the insurance companies, and between states...and therefore have so many people in the U.S. be forced to pay tens of thousands of dollars in order to have a baby...something that so many others can do for free!!! It's SOOOOO expensive, and heartbreaking if you just can't afford it.

Old 06-11-2006, 07:16 AM   #12
Senior Member
Join Date: May 2005
Posts: 132
karenn HB User
Re: Help Please... Insurance is Killing me...

I think AR is mandated to cover it. Blue Cross Blue Shield of Arkansas covers all infertility treatment 80% (in network) 60%(out of network) of the cost with a liftime benefit of $10 000. We will be moving out of state the end of the summer and that is why I am doing IVF this month. It is not the best time for out family - I am so stressed out with all that is going on, but this is my one and only chance. I said to my husband that if we did not have this problem I would have waited at least 18 months before attempting this, but we do not have that option. I am so greatful that we have this oppertunity. I do not think we would have been able to afford it if we did not have the coverage. Friday I had to write 2 checks totalling $5000 it hurt! Hopefully we will get 80% of that back, but our insurance is hinting towards the %60 coverage for out of network provider - even when they do not have an in network labarotory that can do these things such as ICS. I still have not gotten a firm number from the pharmacy regarding how much of our medicine if any is covered.


Last edited by moderator2; 06-11-2006 at 06:30 PM. Reason: please do not ask members to violate the posting rules

Old 06-11-2006, 05:46 PM   #13
Join Date: Jul 2005
Location: Canada
Posts: 318
marriot HB User
Re: Help Please... Insurance is Killing me...

I know it's tough. My insurance doesn't cover ANYTHING to do with infertility. I paid about $8500 last week to begin the IVF process - and that doesn't include what I've already paid to get in to see the specialists ("administration" fees). My clinic did recommend a pharmacy that doesn't charge dispensing fees though (the pharacist is a former fertility patient so she's very sympathetic). I sure hope this works!

Old 06-11-2006, 06:22 PM   #14
Senior Veteran
Join Date: Dec 2005
Location: Chicago, IL
Posts: 977
cmarie313 HB User
Re: Help Please... Insurance is Killing me...

I am so blessed to have such an amazing insurance plan. I am a teacher in Illinois and my plan is Blue Cross Blue Shield. I have 100% infertility coverage! It pays 100% for everything, including 4 tries of IVF. All I have to pay is $15 if I see the actual RE and $10 for each perscription (including injectibles). I am so thankful because I see how hard it is for so many people who do not have good coverage. It is such a stressful and challenging process to start with, let alone having to deal with the financial aspect of it as well!!!! I wish you all the very best and hope that we all get our little miracles soon so we won't have to deal with any of this anymore

Old 06-12-2006, 09:53 AM   #15
Join Date: May 2006
Location: Brooklyn, NY
Posts: 83
MaxTech23 HB User
Re: Help Please... Insurance is Killing me...

well ladies,
I looked it up online and yes, Within Reach, NY is one of the states that is mandated to offer it but my company doesn't have to accept it. I spoke with a woman at a local hospital and she informed me that the few companies that DO cover infertility is - NYS education (all teachers are covered), police officers, hospital staff, Meryll Lynch (need to check their website and see if they have any positions available.) *SMILING*

Had my progesterone shot this morning. I have to say it wasn't as bad as I thought. In fact, I felt the needle stick and that was it! What a relief!!!!
I'm not afraid of needles but when it comes to a needle in my butt, I do get a little crazy. lol.

Hopefully my AF comes down in a couple of days. As for the metformin... YUCK! Talk about stomach problems. Jeez. I'm hoping that in 2 wks these awful side effects are gone.

We'll see what happens.

TONS of BABY DUST to everyone!!
mommy-to-be (one day soon... I hope)

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